Predicting outcomes and personalizing treatment in hepatocellular carcinoma

Predicting outcomes in patients with hepatocellular carcinoma (HCC) is particularly difficult due to the presence of at least two potentially lethal diseases: cancer and liver cirrhosis. In addition, recent years has seen a surge in the number of treatment options, making the choice of the right (order of) treatment increasingly complex. This thesis provides clinicians with specific considerations and easy-to-use tools for the prognostic assessment prior to loco-regional treatment (part I) or systemic treatment (part II) of incurable HCC.
Transarterial chemoembolization (TACE) and selective internal radiation therapy (SIRT) are the most frequently applied loco-regional treatments for HCC in a palliative setting. This thesis showed the prognostic relevance of several parameters prior to TACE, including the liver function, disease etiology and tumor stage. After TACE, the radiological response was significantly associated with survival and the majority of cases with progression appeared to be eligible for subsequent treatment. Hepatobiliary scintigraphy showed that SIRT induced a significant loss of liver function in treated liver regions, without effective hypertrophy in the untreated liver regions. This suggests that SIRT may be more effective in patients with a limited tumor burden and preserved liver function.
Sorafenib is the current standard treatment for patients with advanced-stage HCC. Several studies in this thesis highlighted the importance of adequate patient selection for sorafenib treatment, taking the patient’s liver function, tumor stage and condition into consideration.
To support clinical decision making, statistical models were built for both TACE and sorafenib treatment. These models are more accurate than currently available algorithms and easily useable thanks to the online calculators. These models can aid in clinical decision making and may lead to more personalized treatment in patients with incurable HCC.